Healthcare Provider Details

I. General information

NPI: 1982941191
Provider Name (Legal Business Name): VELVET BROWN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAPITOLA DR
DURHAM NC
27713-4496
US

IV. Provider business mailing address

11 LOGGING TRL
DURHAM NC
27707-4656
US

V. Phone/Fax

Practice location:
  • Phone: 919-474-6373
  • Fax:
Mailing address:
  • Phone: 919-357-1416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP007683
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: